health reform 201

Health Reform 201 Impact of ACA Repeal & Replace in Utah

Moab Regional Hospital February 13, 2017

Who is UHPP?

Utah Health Policy Project is a non-profit, non-partisan organization advancing sustainable health care solutions for underserved Utahns, through better access, education, and public policy

www.healthpolicyproject.org

www.facebook.com/uthpp

@UHPP

Private insurance is sold in three markets

Individual

An individual or family policy purchases a policy directly from a private insurance company

Employer: Self-insured

Employer: Small group

Employer-based insurance often subsidized by the company for employees and their dependents

A group health plan in which the employer assumes risk for providing health care benefits to employees

Photo Source: Princeton Public Library; MatthewRoth; VictorPorof

6%

50%- 60%

Key Terms

Medicaid

Medicare

Government health insurance for kids

Government health insurance for low-income kids, pregnant women, seniors, and people with disabilities

CHIP

Government health insurance for senior citizens (ages 65+)

Photo Source: jaime22; Albuquerque Public Schools

Key Terms

Private insurance plans sold on healthcare.gov with monthly premiums subsidized for some people

ACA or Obamacare Insurance

Where Utah Stands in Early 2017

April 2014 February 2015 February 2016

706

1,028 1,018

0

200

400

600

800

1,000

1,200

1 2 3

Moab

Enrollment in Grand County leveled off in 2016

Sources: [2014] Plan Selections by ZIP code in the Health Insurance Marketplace; Date: 2014-09-01; 10/1/2013 thru 4/19/14; https://aspe.hhs.gov/plan-selections-zip-code-health-insurance-marketplace-september-2014; [2015B] ASPE 2015 Health Insurance Marketplace Plan Selections by ZIP Code; Date 2015-04-01; (Nov. 15, 2014 — Feb. 22, 2015); http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/EnrollmentByZip/rpt_EnrollmentByZip_Apr2015.cfm; [2016] Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; Date: 2016-03-11; For the period: November 1, 2015 – February 1, 2016; https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report

County Arches customers (2015)

Beaver 209

Box Elder 592

Cache 2,162

Carbon 719

Daggett 44

Davis 2,254

Duchesne 598

Emery 352

Garfield 244

Grand 885

Iron 1,078

Juab 425

Kane 353

Millard 321

Morgan 122

County Arches customers (2015)

Rich 80

Salt Lake 7,333

San Juan 307

Sanpete 816

Sevier 731

Summit 1,050

Tooele 714

Uintah 1,160

Unknown 87

Utah 4,566

Utah 220

Wasatch 872

Washington 5,036

Wayne 90

Weber 1,231

The Oct. 2015 collapse of Arches hit Grand County hard

2017: 13 Plans

1 plan

5 plans

5 plans

2 plans

0 plans

Sources: [2014] https://https://insurance.utah.gov/health/Health%20Refrom/ACA_Rate_Individual_20131007_OnExchange.pdf; [2015] Utah – On Exchange Rates (accurate as of 10/15/14) https://insurance.utah.gov/health/Health%20Refrom/2015IndividualOnExchange20141016.pdf; [2016] www.hea;thcare.gov; See Plans and Premiums (October 2015); [2017] 2017 Utah Individual Rates; Utah Dept. of Insurance ; version 2; 9/27/16

Altius Health Plans Arches BridgeSpan Select Health

3 plans

12 plans

15 plans

10 plans

0 plans

Select Health (20)

2015: 53 Plans 2016: 20 Plans

Altius Health Plans Arches BridgeSpan Select Health

2014: 40 Plans

Gold

Silver

Bronze

Catastrophic

Platinum

1 plan

5 plans

8 plans

6 plans

2 plans

2 plans

15plans

22 plans

15 plans

0 plans

2014-17 Individual Marketplace Comparison Grand County

Select Health (9) University of Utah (4)

Sources: [2014] https://https://insurance.utah.gov/health/Health%20Refrom/ACA_Rate_Individual_20131007_OnExchange.pdf; [2015] Utah – On Exchange Rates (accurate as of 10/15/14) https://insurance.utah.gov/health/Health%20Refrom/2015IndividualOnExchange20141016.pdf; [2016] www.hea;thcare.gov; See Plans and Premiums (October 2015); [2017] 2017 Utah Individual Rates; Utah Dept. of Insurance ; version 2; 9/27/16

2014-17 Benchmark Silver Comparison Grand County

$167 $167

$221

$261

$0

$50

$100

$150

$200

$250

$300

2014 2015 2016 2017

Unsubsidized Benchmark Silver monthly premium for 21-year, non-tobacco user (Grand Co.)

In 2017 95% of Utahns will have access to two or more marketplace insurers – Grand Co. gained UofU Health Plans

Accessible Insurers

Utah Population (2014)

% of Utah Population

(2014)

Molina; SelectHealth; Univ.

of Utah Health Plans

2,375,104 80.7%

SelectHealth; Univ. of Utah Health

Plans 424,851 14.4%

SelectHealth 142,947 4.9%

3 insurers

2 insurers

1 insurer

+

+

+

+ +

+ + +

+ Gained one insurer in 2017

84,601

140,612

175,637

-

50,000

100,000

150,000

200,000

250,0001

0/3

1/1

3

11

/30

/13

12

/31

/13

01

/31

/14

02

/28

/14

03

/31

/14

04

/30

/14

05

/31

/14

06

/30

/14

07

/31

/14

08

/31

/14

09

/30

/14

10

/31

/14

11

/30

/14

12

/31

/14

01

/31

/15

02

/28

/15

03

/31

/15

04

/30

/15

05

/31

/15

06

/30

/15

07

/31

/15

08

/31

/15

09

/30

/15

10

/31

/15

11

/30

/15

12

/31

/15

01

/31

/16

02

/29

/16

03

/31

/16

04

/30

/16

05

/31

/16

06

/30

/16

07

/31

/16

08

/31

/16

09

/30

/16

10

/31

/16

11

/30

/16

12

/31

/16

01

/31

/17

Utah’s sign-ups on healthcare.gov reached 197,187 in 2017

[OE1-a] Health Insurance Marketplace: February Enrollment Report (Oct. 1, 2013-March 1, 2014), http://aspe.hhs.gov/health/reports/2012/ACA-Research/index.cfm; [OE1-b] Health Insurance Marketplace: November Enrollment Report (November 13, 2013), For the period: October 1, 20134 - November 2, 2013, https://aspe.hhs.gov/sites/default/files/pdf/180496/rpt_enrollment.pdf [OE1-c] Health Insurance Marketplace: January Enrollment Report (January 13, 2014), For the period: October 1, 2013 – December 28, 2013, https://aspe.hhs.gov/sites/default/files/pdf/177611/ib_2014jan_enrollment.pdf [OE1-d] Health Insurance Marketplace: February Enrollment Report February 12, 2014), For the period: October 1, 2013 – February 1, 2014, https://aspe.hhs.gov/sites/default/files/pdf/177606/ib_2014feb_enrollament.pdf [OE1-e] Health Insurance Marketplace: March Enrollment Report (March 11, 2014), For the period: October 1, 2013 – March 1, 2014, https://aspe.hhs.gov/sites/default/files/pdf/76811/ib_2014Mar_enrollAddendum.pdf [OE1-f] Health Insurance Marketplace: Summary Enrollment Report: State Profile, (May 1, 2014), https://aspe.hhs.gov/sites/default/files/pdf/93806/ut.pdf ----------- [OE2-a] Health Insurance Marketplace: December Enrollment Report, (December 30, 2014), For the period: November 15, 2014 – December 15, 2014, https://aspe.hhs.gov/sites/default/files/pdf/77201/ib_2014Dec_enrollment.pdf [OE2-b] Health Insurance Marketplace: January Enrollment Report, (January 27, 2015), For the period: November 15, 2014 – January 16, 2015, https://aspe.hhs.gov/sites/default/files/pdf/33826/ib_2015jan_enrollment.pdf [OE2-c] Health Insurance Marketplace: March Enrollment Report, (March 10, 2015), For the period: November 15, 2014 – February 22, 2015, https://aspe.hhs.gov/sites/default/files/pdf/83656/ib_2015mar_enrollment.pdf; [OE2-d] State-Level Data from the ASPE January Health Insurance Marketplace Enrollment Report For The 2016 Open Enrollment Period; March 31, 2015 Effectuated Enrollment Snapshot; 15-06-02; http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-06-02.html ----------- [OE3-a] Health Insurance Marketplace: January Enrollment Report, (January 7, 2016), For the period: November 1, 2015 – December 26, 2015, https://aspe.hhs.gov/sites/default/files/pdf/167981/MarketPlaceEnrollJan2016.pdf; [OE3-b] Health Insurance Marketplace Open Enrollment Snapshot - Week 11; January 10, 2016 - January 16, 2016 (Released: 1/20/16); Health Insurance Marketplace Open Enrollment Snapshot - Week 13 January 24, 2016-February 1, 2016; https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html; [OE3-c] Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report (March 11, 2016), For the period: November 1, 2015 – February 1, 2016, https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf; [OE3-d] March 31, 2016 Effectuated Enrollment Snapshot (Released: June 30, 2016), https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-30.html ---------- [OE4] - [2017 Final] Biweekly Enrollment Snapshot; Weeks 12 through 14; Date 2017-02-03; Weeks 12-14; 11/1/16 thru 1/31/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-02 03.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2017] Biweekly Enrollment Snapshot; Date 2017-01-18; Weeks 10-11; 11/1/16 - 1/14/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-18.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2016] Biweekly Enrollment Snapshot; Date 2017-01-04; Weeks 8-9; 11/1/16 - 12/31/16; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-04.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending

197,187

Utah’s ACA enrollment grew 12.3%

in 2017

Rank State 2016 Open

Enrollment 3 (Final)

2017 Open Enrollment 4

(Final)

Difference (#)

Difference (%)

1 Hawaii 14,564 18,938 4,374 30.0%

2 South Dakota 25,999 29,622 3,623 13.9%

3 Utah 175,637 197,187 21,550 12.3%

4 Oregon 147,109 155,430 8,321 5.7%

5 Wyoming 23,770 24,826 1,056 4.4%

6 New Jersey 288,573 295,067 6,494 2.3%

7 North Dakota 21,604 21,982 378 1.7%

8 Wisconsin 239,034 242,863 3,829 1.6%

9 Nevada 88,145 89,061 916 1.0%

10 Florida 1,742,819 1,760,025 17,206 1.0%

Utah’s marketplace enrollment increased 12.3% this year

Sources: [2017 Final] Biweekly Enrollment Snapshot; Weeks 12 through 14; Date 2017-02-03; Weeks 12-14; 11/1/16 thru 1/31/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-02-03.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2016 Final] Health Insurance Marketplace Open Enrollment Snapshot - Week 13; Date 2016-02-04; Week 13; 11/1/15 thru 1/31/16; https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html

Sources: [2017 Final] Biweekly Enrollment Snapshot; Weeks 12 through 14; Date 2017-02-03; Weeks 12-14; 11/1/16 thru 1/31/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-02 03.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending;[2017] Biweekly Enrollment Snapshot; Date 2017-01-18; Weeks 10-11; 11/1/16 - 1/14/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-18.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2016 Final] Health Insurance Marketplace Open Enrollment Snapshot - Week 13; Date 2016-02-04; Week 13; 11/1/15 thru 1/31/16; https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html; [2016] Biweekly Enrollment Snapshot; Date 2017-01-04; Weeks 8-9; 11/1/16 - 12/31/16; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-04.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2015] Health Insurance Marketplace Open Enrollment Snapshot - Week 9; December 27, 2015 – January 2, 2016; Link: https://WWW.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-01-06.html; [OE3; 2016] Health Insurance Marketplace Open Enrollment Snapshot - Week 11; Date 2016-01-20; Weeks 10-11; 11/1/15 - 1/16/16; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-01-20.html; [2016] Biweekly Enrollment Snapshot; Date 2017-01-04; Weeks 8-9; 11/1/16 - 12/31/16; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-04.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2015] Health Insurance Marketplace Open Enrollment Snapshot - Week 9; December 27, 2015 – January 2, 2016; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-01-06.html

43,071

35,534

34,637

8,565

16,014

43,390

54,806

41,245

2,812

8,282

0

10,000

20,000

30,000

40,000

50,000

60,000

Week 4 Week 6 Week 7 Week 9 Week 11 Week 13

OE 3 (2015-16)

OE 4 (2016-17)

President Trump takes office

Bi-weekly Enrollment Growth

in Covered Lives

Last-minute sign-ups in January 2017 were 55% lower than in the previous year (2016)

In 2016, 13 of Utah’s top 20 ZIP codes for ACA enrollment were outside of Salt Lake

County

Source: 2016 Health Insurance Marketplace Plan Selections by ZIP Code; (Nov. 1, 2015 — Jan. 9, 2016); https://aspe.hhs.gov/basic-report/plan-selections-zip-code-health-insurance-marketplace-january-2016

RANK CITY SELECTIONS % INCREASE 1 Lehi (84043) 3,501 19% 2 South Jordan (84095) 3,346 12% 3 American Fork (84003) 2,948 17% 4 Pleasant Grove (84062) 2,931 20% 5 St. George (84790) 2,829 10% 6 St. George (84770) 2,742 11% 7 Draper (84020) 2,624 13% 8 Bountiful (84010) 2,455 5% 9 Spanish Fork (84660) 2,377 24%

10 West Valley City (84119) 2,368 3% 11 West Valley City (84120) 2,345 13% 12 Provo (84604) 2,289 22% 13 Herriman (84096) 2,276 20% 14 Clearfield (84015) 2,258 3% 15 Riverton (84065) 2,255 23% 16 Cottonwood Heights (84121) 2,254 6% 17 Orem (84058) 2,196 24% 18 Orem (84057) 2,193 16% 19 Ogden (84404) 2,189 1% 20 Layton (84041) 2,110 12%

After dropping rapidly from 2013-15, the U.S. uninsured rate is leveling off

ACA Coverage Available

Source: Gallup Healthways Well-Being Index (Q4 2015)

U.S. Uninsured Rate by Quarter (2008-2015)

Source: [2015] U.S. Census: 2006-2015 American Community Survey 1-year estimates , S2701 (https://www.census.gov/programs-surveys/acs/) [2014] www2.census.gov/programs-surveys/acs/tech_docs/accuracy/ACS_Accuracy_of_Data_2014.pdf [2006-2013] http://www.census.gov/did/www/sahie/data/interactive/sahie.html

The latest U.S. Census data shows a 16% drop in the Utah’s uninsured rate between 2014-15

16.7%

15.7% 16.3%

15.9%

16.7% 16.6%

15.7%

14.0%

12.5%

10.5%

8%

9%

10%

11%

12%

13%

14%

15%

16%

17%

18%

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

16%

ACA Coverage Available

In Utah, the uninsured rate for people earing over 200% of poverty has declined the most

Source: [2015] U.S. Census: 2006-2015 American Community Survey 1-year estimates , S2701 (https://www.census.gov/programs-surveys/acs/) [2014] www2.census.gov/programs-surveys/acs/tech_docs/accuracy/ACS_Accuracy_of_Data_2014.pdf [2006-2013] http://www.census.gov/did/www/sahie/data/interactive/sahie.html

-28% -30% -25%

Utah Uninsured Rate by Income Level (2009-2015)

Source: U.S. Census Bureau, 2015 American Community Survey 1-Year Estimates

American Indians and Hispanics experience the highest rates of being uninsured in Utah

7.1%

10.8% 13.4% 14.1%

22.5%

26.8%

32.8%

36.0%

0%

5%

10%

15%

20%

25%

30%

35%

40%

White alone,not Hispanic

or Latino

Two or moreraces

Black orAfrican

Americanalone

Asian alone NativeHawaiian andOther Pacific

Islander alone

Hispanic orLatino (of any

race)

Some otherrace alone

AmericanIndian and

Alaska Nativealone

Utah average: 10.5%

0% 101% 400% 100%

Who is eligible for premium subsidies?

Income as % of the Federal Poverty Level (FPL)

NO YES 70,000 Utahns

in the Gap

Sliding-scale subsidies make insurance more affordable

The 2016 FPL guidelines are applied to the 2017 Marketplace plans. These guidelines only apply to the Lower 48 States (Alaska and Hawaii have their own guidelines). Source: Link: http://familiesusa.org/product/federal-poverty-guidelines

For 2017, a family of four can earn about $97,000 a year and receive a premium subsidy

If your income/family size is on this chart, you qualify for a subsidy

The Hernandez Family Residence: Moab, Utah Ages: Dad : 33 Mom: 29 Kids: 11, 7

Annual income: $26,000

% of poverty level: 109%

Monthly premium: $725

Subsidy pays: $665 per month

The Hernandez’s pay: $60 per month

Primary doctor: $10 Specialist doctor: $15 Emergency room care: $100 Generic drugs: $10

Plan Details

Deductible: $200 Out-of-pocket maximum: $2,000 Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard

How much does the Hernandez family pay for

health insurance?

Kids on Medicaid

Benchmark Silver plan

Parent-only coverage





Jill pays: $201 per month


Plan Details

Deductible: $1,300 Out-of-pocket maximum: $5,100 Source: https://www.healthcare.gov/see-plans/; Image source: http://www.tourplicity.com

How much does Jill pay for health

insurance?


Cheapest Bronze plan is $123/month with $5,700 deductible

Jill Residence: Moab, Utah Age: 35





The Shumway’s pay: $277 per month


Plan Details

Deductible: $2,600 Out-of-pocket maximum: $10,200 Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard

How much does the Shumway family pay for

health insurance?

Benchmark Silver Plan (5 Silver plans available)

Cheapest Bronze plan is $105/month with $11,400 deductible

The Shumway Family Residence: Castle Valley, UT Ages: Dad : 24 Mom: 23 Kid: Newborn



Monthly premium: $1,566

Subsidy pays: $1,231 / month

The Smith’s pay: $335 per month


Plan Details


How much do the Smith’s pay

for health insurance?


Covers 5 doctors in Moab area (Drs. Andrew, Munger, Quinn, Stevens, K. Williams, K. Williams)

The Smiths Residence: Moab, UT Ages: 62, 60





The Simonsens’ pay: $1,215 per month


Plan Details


How much do the Simonsen’s pay for health

insurance?


Benchmark premium increased 15% ($150) from 2016

The Simonsen Family Residence: Moab, Utah Ages: Dad : 44 Mom: 35 Kids: 11, 7




Subsidy pays: $0 / month

The Phillips’ pay: $1,139 / month


Plan Details


How much do the Phillip’s pay

for health insurance?

Kids covered by Medicaid

Parents are caught in the Utah Medicaid Coverage Gap

The Phillips Family Residence: Moab, Utah Ages: Dad : 35 Mom: 33 Kids: 11, 7

Utah has the nation’s highest percentage (25%) of children enrolled in ACA coverage

Age

37 FFM* states

10% 10%

16%

16% 20%

27%

1%

25%

12%

19%

16%

12%

15%

< 18

Age 18-25

Age 26-34

Age 35-44

Age 45-54

Age 55-64

Age 65+

56% of Utah enrollees are under age 34

Source: Health Insurance Marketplaces 2017 Open Enrollment Period: January Enrollment Report; Date: 1/10/17; For period 11/1/16 to 12/24/16; Weeks 8-9; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-10.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending

Utah

(*) FFM stands for Federally-managed

marketplace (healthcare.gov)

85% of Utahns enrolling on healthcare.gov received a premium subsidy

No subsidy

Received subsidy

Subsidy Status

85%

15%

83%

17%


Utah

37 FFM states

Most Utahns choose Silver-level plans that offer a balance between premiums and cost-sharing

24%

73%

3%

21%

74%

4% 1%

Bronze

Silver

Gold

Catastrophic

Subsidy Status


Utah

37 FFM states

Most ACA enrollment in Utah is in urban ZIP codes

Urban areas

Rural areas

Geography


15%

85%

18%

82%

Utah

37 FFM states

ACA subsidies cover 69% of average monthly premiums for Utah enrollees

Impact of monthly subsidies on ACA insurance premiums

$187

$84

(69%)

(31%) Utah

Average Monthly

Premium: $271

Subsidy Amount

Consumer Cost

Subsidy Impact

Source: Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; For the period: November 1, 2015 – February 1, 2016 https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report; Released: March 11, 2016

Utah

37 FFM states

$290 (73%)

$106 (27%)

72% of Utah’s ACA enrollment earns below 250% of the poverty level


31%

22%

19%

9%

8%

34%

22%

14%

8%

9%

100% to 150%

151% to 200%

201% to 250%

251% to 300%

Poverty Level

301% to 400%

Utah

37 FFM states

Over half of re-enrolling marketplace consumers in Utah switched plans in 2016

Origin of Utah ACA enrollment

Active vs. Auto status for re-enrollments

Newly enrolled

Re-enrolled

23%

77%


56% 21%

Active re-enrollment

Auto re-enrollment

The Affordable Care Act, also called Obamacare, is going to be repealed and

replaced in the near future.

DEC

EMB

ER 1

6

The latest health insurance calendar

Next Open Enrollment: Nov. 1, 2017 -- Dec. 15, 2017

Open Enrollment

Open Enrollment

Special Enrollment

2017

FEBRUARY 1 NOVEMBER 1 OCTOBER 31 JANUARY 31 JAN

UA

RY

1

DEC

EMB

ER 1

6

Open Enrollment

Special Enrollment

2018 (proposed)

FEBRUARY 1 NOVEMBER 1 OCTOBER 31

JAN

UA

RY

1

45 days (proposed)

How can ACA insurance premiums vary?

(in billions) 1) Age (new ratio of 3:1)

2) Tobacco use (ratio of 1.5:1)

3) Geography (by counties)

Area 1: Cache and Rich Area 2: Box Elder, Morgan, and Weber Area 3: Davis, Salt Lake, Summit, Tooele, and Wasatch Area 4: Utah Area 5: Iron and Washington Area 6: Beaver, Carbon, Daggett, Duchesne, Emery, Garfield, Grand, Juab, Kane, Millard, Piute, San Juan, Sanpete, Sevier, Uintah, and Wayne

(in billions)

1) Age (new ratio of 5:1)

2) Tobacco use (ratio of 1.5:1)

3) Geography (by counties)

4) Gender (women pay more)

5) Health history (higher premiums for pre-existing conditions)

After Repeal

How the ACA changed healthcare (as we know it)

Adults under age 26 can stay on

their parents insurance

plan

Men and women pay the same for coverage

Insurance offers free preventative care like blood pressure checks, flu shots, and health screenings

No one can be denied or priced out of coverage for a

pre-existing condition

No lifetime caps on insurance payments

2010 2013

18.4%

29.0% Utah Uninsured Rate Ages 18-26:

Source: Utah DOH

Adults under age 26 can stay on

their parents insurance

plan

Men and women pay the same for coverage

Insurance offers free preventative care like blood pressure checks, flu shots, and health screenings

No one can be denied or priced out of coverage for a

pre-existing condition

No lifetime caps on insurance payments

2010 2013

18.4%

29.0% Utah Uninsured Rate Ages 18-26:

Source: Utah DOH

After Repeal

All plans will have essential benefits

1. Ambulatory (ie. out-patient) services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance use disorder services,

including behavioral health treatment 6. Prescription drugs 7. Rehabilitative and habilitative services and devices 8. Laboratory services 9. Preventive and wellness services and chronic disease

management 10. Pediatric services, including dental and vision care

Source: http://cciio.cms.gov/resources/factsheets/ehb-2-20-2013.html

Adult dental and vision can be purchased as extras

No plans will have essential benefits

After Repeal

In January 2017, Rep. Steve Drazkowski, a state legislator from Minnesota, proposed an amendment that would have

allowed insurers to omit any or all of 68 coverage areas

mandated under the federal Affordable Care Act. The

amendment was removed during a conference committee.

Source: ”Drazkowski "Pick Sicks" amendment stripped from MN health care insurance premium relief bill,” Bluestate Prairie; http://www.bluestemprairie.com/bluestemprairie/2017/01/drazkowski-pick-six-amendment-stripped-from-mn-health-care-insurance-premium-relief-bill.html

What is the ACA marketplace like?

After Repeal

What are the penalties for remaining uninsured in 2017?

$695 per adult

$347.50 per child

Up to $2,085 per household*

…or 2.5% of adjusted

gross income**

(*) Flat fee is adjusted for inflation after 2016 (**) Gross income minus

the filing threshold

Which-ever is higher…

$695 per adult

$347.50 per child

Up to $2,085 per household*

…or 2.5% of adjusted

gross income**

(*) Flat fee is adjusted for inflation after 2016 (**) Gross income minus

the filing threshold

The new administration could eliminate the individual mandate/fine in 2017… …as well as the

employer mandate

After Repeal

• Insurers will exclude benefits and charge higher premiums for some people with pre-existing conditions

• Annual and lifetime payment caps will come back

• High-risk pools will return to cover the uninsurable

• Women will be charged higher premiums than men

• Premiums will increase for people over age 40

• Caps on high-deductible plans will be lifted

• Essential health benefits will be eliminated

• Premium tax credits likely will be based on age, not income or family size

Individual market insurance after the ACA…

Stopping discrimination against pre-existing conditions requires an insurance mandate and

premium subsidies

Remove the mandate to purchase insurance, and the whole system collapses

Discrimination against pre-existing conditions is common to all ACA replacement plans

Rep. Tom Price H.R. 2300 “Empowering Patients First Act” Page 151

Speaker Paul Ryan “A Better Way Plan” Page 20

Utah newspaper headlines from 2010…. or 2018?

All ACA replacement plans include exclusion periods for pre-existing conditions if continuous

coverage is not maintained

Consumers will be

caught by trapdoors and fine

print

Annual and lifetime caps on insurance benefits will return for many plans

Insurers will review medical records for evidence of pre-existing conditions

Speaker Paul Ryan “A Better Way Plan” Page 21

High-risk pools are only needed if consumers are denied or priced out of insurance coverage

because of pre-existing conditions

Real premiums for different age groups

Repealing the ACA will double the insurance costs for the Shumway family….

Source: healthcare.gov; “See Plans and Premiums;” Salt Lake County, identical family size and ages; accessed 2/3/17

Many low and middle-income Utah families will pay more for insurance if the ACA is repealed

Income (annual)

$120,000

$120,000

Premium (monthly)

[annual

$936 [$11,232]

$800 [$9,600]

-15%

Deductible

(annual)

$3,000

$6,000

+100%

Out-of-

Pocket Max (annual)

$14,300

$10,000

-14%

Total Cost (premiums

+ max)

$25,632

$19,600

-23%

Total Cost minus tax

credit

$25,632

$11,200

-56%

Total

Cost as % Income

21%

9.3%

-55%

Premium Subsidy (annual)

None

$6,000

Source: healthcare.gov; “See Plans and Premiums;” Salt Lake County, identical family size and ages; accessed 2/3/17

ACA

Replace Plan

(H.R. 2300)

Repealing the ACA will cut insurance costs for the Simonsen family by 50%….

The Simonsens| Family of 4

Yet, higher-income Utah families will pay less for insurance if the ACA is repealed

Difference between Plans

• Allow health plans to expand the age ratio from 3:1 to 3.49:1, letting insurers increase premiums for older customers

• Cut the 2018 enrollment period in half by ending it on December 15 rather than January 31 (start date would remain November 1)

• Require extra documentation to prove special enrollment applicants are eligible before coverage takes effect

• Allow insurers more wiggle room on plan actuarial values so that Silver plan cover 66%of medical costs—2% less than now.

• Tightens rules around the 90-day-grace period for enrollees who stop paying premiums.

Trump administration weighs Obamacare changes sought by insurers February 6, 2017 By Dan Diamond, Jennifer Haberkorn, and Paul Demko

Source: Trump administration weighs Obamacare changes sought by insurers; 2/6/17; http://www.politico.com/story/2017/02/trump-obamacare-insurance-companies-234707

Timeline* for ACA Repeal and Replace

(*) Absolutely going to change.

March/April 2017:

April/May 2017:

Initial House votes on repeal legislation using budget reconciliation process (avoiding Senate filibuster). Yet Senate wants to slow down this time-table

Insurers start to file rates and intentions for 2018 marketplace—must have assurances on risk pools

Statement by President Trump on 2/5 about his slower timeline for ACA repeal—hints at plan to “repeal now, replace later”

“…by the end of the year, at least the rudiments…"

Ways to Repair the ACA • Fix the “family glitch” so that family members priced out of

employer-based coverage can get subsidies to purchase marketplace insurance

• Add tax credits for consumers on individual market earning above 400% of poverty level

• Increase contribution amounts to health savings accounts (HSAs)

• Create “Copper Plan” with high deductibles, low premiums, and open to all consumers regardless of age, income

• Allow more small business “association health plans” sponsored by business and professional organizations

• Allow Medicare to negotiate for prescription drugs

• Allow insurers to sell policies across state lines (mostly harmless)

Proposal by Speaker Paul Ryan

Free preventive screenings: none. Essential health benefits: none. Tax penalty: none.

A Better Way Our Vision for a Confident America

There will be a cap on the pre-tax value of job-based insurance. Pre-tax contributions to an HSA will be excluded. 5:1 instead of 3:1, but states have the power to choose.

Women will once again be charged more for health insurance than men.

1) Pre-existing conditions

2) High risk pools

3) Employee contribution 4) Age ratio 5) Women vs. men

Cannot be turned away due to illness. Patient protection for those who maintain continuous coverage. But, if there is a lapse in coverage (likely 62 days), you can be charged above standard rates. $25 billion of federal funding allocated to “robust” high risk pools. Premiums will be capped and wait lists prohibited.

1

State insurer boundaries: none. Deductible caps: none. Healthcare.gov: none.

Young adults will be covered on their parent’s plan until 26 years, but states will have the authority to change this. States can choose to receive block grant funding or default into a per capita allotment. Effective 2019.

6) Open enrollment

7) Tax credits

8) Coverage until 26 9) Medicaid

There will be a one-time open enrollment for the uninsured to join the health care market. If you “choose” not to enroll, you will lose “continuous coverage protection. Universal advanceable, refundable tax credits that will be fixed by age. Anyone not offered job-based coverage, Medicare, or Medicaid can receive credits.

A Better Way Our Vision for a Confident America

2

Proposal by Speaker Paul Ryan

Proposal by Rep. Tom Price

Free preventive screenings: none. Essential health benefits: none. Tax penalty: none.

H.R. 2300 Empowering Patients First Act

Employer exclusions of health care coverage allowed up to $20,000 per family and $8,000 per individual. Funds exceeding these limits will be taxed. States will determine their age ratio.

1) Pre-existing conditions

2) High risk pools

3) Employee contribution 4) Age ratio

Insurers could impose 18-month waiting periods on pre-existing conditions with a 6-month look-back window, or impose a premium surcharge up to 150% of the standard premium if pre-existing conditions are not excluded. $1 billion of federal funding allocated to high risk/reinsurance pools. Effective 10-1-2018.

1

State boundaries: none | Deductible caps: none | Healthcare.gov: none

Women will once again be charged more for health insurance than men. Medicaid expansion will be eliminated. More tbd.

5) Tax credits

6) Coverage until 26

7) Women vs. men 8) Medicaid

Fixed credits based on age. Tax incentives for maintaining health coverage. Available only to US citizens and lawful permanent residents. States have the authority to determine the age by which young adults can remain on their parents plan.

H.R. 2300 Empowering Patients First Act

2

Proposal by Rep. Tom Price

Empowering Patients First Act

Annual tax credit break down

$900 per child up to age 18

$1,200 for ages 18 to 35

$2,100 for ages 35 to 50

$3,000 for ages 50+

*maximum amount allotted per person per year

ACA Replacements side by side

A Better Way Empowering Patients First

Medicaid

Source: A Better Way our Vision for a Confident America and Empowering Patients First Act (H.R. 2300)

Pre-existing conditions

High Risk Pools

Tax credits

Open enrollment

Employee Contributions

Tax penalty

Free preventive care

One-time open enrollment. If you “choose” not to enroll, you will lose “continuous coverage protection”

Cap the pre-taxable amount for job-based coverage

Fixed credit based on age. Universal advanceable, refundable tax credit.

“Robust” high risk pools -$25 billion federal funding. Premium caps, no wait lists

Patients protected if they maintain continuous coverage

None

None

Waiting period up to 18 months, or 150% surcharge

High-risk/reinsurance pools -$1 billion federal funding

TBD

Employer exclusion allowed to $8K/$20K, any funds above are taxable

Tax incentives for maintaining coverage, fixed amount based on age.

None

None

States decide: block grant or per capita allotment Medicaid expansion eliminated

Rep. Jason Chaffetz UT-3

WASHINGTON, DC 2236 Rayburn House Office Building Washington, DC 20515 Phone: (202) 225-7751 Hours: M-F 9AM-6PM EST

PROVO 51 S University Ave. Suite 318 Provo, UT 84601 Phone: (801) 851-2500

Get Involved….

Download this presentation

http://www.slideshare.net/UHPPShare/health-reform-201

Eric Armstrong

Navigator Utah Health Policy Project 801-599-2768 [email protected]

Luis Rios

Navigator Utah Health Policy Project 801.433.2299 x26 [email protected]

Got Questions?

What ACA enrollment looks like

Window-shop for insurance now…

https://www.healthcare.gov/see-plans

What is a Qualifying Life Event? ….that triggers a Special Enrollment Period

Who are the helpers? Navigator

Certified Application Counselor

Experts trained to help others evaluate their insurance options on the new insurance marketplace.

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www.takecareutah.org | call 2-1-1

TCU’s trained counselors are ready to help you understand your new options to find affordable

health care coverage today

Where can Utahns find help applying for health insurance?

health reform 201

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